MEDICARE: DR. JORGE V COLON MARTINEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	17480	PR

General Provider Information

NPI Number	:	1134360779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE V COLON MARTINEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 651
Second Line	:
City	:	MERCEDITA
State	:	PR
Zip	:	00715-0651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE JOSE C VAZQUEZ INTERIOR
Second Line	:	BO CAONILLA
City	:	AIBONITO
State	:	PR
Zip	:	00705-1234
Country	:	US
Telephone Number	:	787-975-4966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	08/10/2019

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